You know the feeling — the itchy eye that is just begging to be scratched. But before you start rubbing, you may want to think twice. While eye rubbing may seem harmless, it puts you at risk of infections or damage to your cornea. Fortunately, there are a number of common causes of itchy eyes that can be treated to reduce the urge to rub.
Causes of eye rubbing
Rubbing your eyes is often a reaction that occurs when your eyes feel uncomfortable or itchy.
The most common reason for that itchy sensation is allergic conjunctivitis, which accounts for nearly 50% of itching cases. Allergic conjunctivitis is an inflammatory reaction of the conjunctiva — the clear skin on the surface of the eye. Allergens bind to the surface of cells, ultimately leading to the release of inflammatory chemical molecules that trigger the sensation of itching. People may experience redness, swelling and little bumps on the inside of the eyelids.
Sometimes the urge to rub happens if there is a gritty sensation, dryness or something stuck in the eye. This is often a symptom of dry eye syndrome or blepharitis.
The urge to rub can also occur because the eyelids feel itchy, often from conditions such as dermatitis — an inflammation of the eyelid skin. Because of the thin outer layer of the eyelid, called the epidermis, it is more vulnerable to irritation from the environment or from contact lenses.
Eye rubbing is a risk factor for corneal disease
The most serious risk associated with eye rubbing is the development of keratoconus — a condition in which the cornea, the clear window in the front of the eye, becomes progressively thinner and more irregular in shape.
While healthy corneas have a more spherical shape, those with keratoconus become steeper and cone-shaped, often causing high degrees of irregular astigmatism and blurry vision.
Fortunately, keratoconus can now be treated with a procedure called corneal cross-linking, which can halt further progression in many cases. During this procedure, collagen strands are cross-linked together, strengthening the cornea. Many patients still need specialized contact lenses to achieve optimal vision even after treatment, and in the most advanced cases, corneal transplantation may be required.
Other conditions associated with eye rubbing
A corneal abrasion is a scratch in the thin, clear skin covering the cornea, triggered by aggressive rubbing or a fingernail that inadvertently touches the eye. An abrasion is extremely painful, usually causes blurry vision and requires antibiotic treatment to prevent infection.
Eye rubbing can also cause a subconjunctival hemorrhage — when rubbing breaks a small blood vessel on the surface of the eye, making it appear very red. While it can look alarming, it is essentially a bruise on the surface of the eye and does not cause lasting damage, typically resolving in one to two weeks without any intervention.
Conjunctivitis, commonly known as pink eye, is an infection of the conjunctiva that can be spread by eye rubbing. It can be caused by viruses or bacteria. Washing your hands before touching your eyes is a good practice to prevent the spread of infection. Viral conjunctivitis is highly contagious, so be particularly careful if you have had contact with someone who has pink eye.
Treatments for itchy eyes
Most people rub their eyes without even realizing it. But there are ways to address the underlying conditions that trigger the urge.
Often, over-the-counter treatments and home remedies can be quite helpful. One approach that addresses most underlying causes is to use artificial tears — and cooling them in the refrigerator helps too.
In cases of allergic conjunctivitis, try to avoid the allergen that triggers symptoms. If allergies are due to pollen, staying indoors, wearing sunglasses or rinsing your face after outdoor exposure can help. The next option is over-the-counter artificial tears to rinse out allergens. In general, avoid drops that advertise "get the red out" — these provide only temporary relief and carry risks of side effects. Cool compresses can also reduce the urge to rub.
If itching persists, try allergy eye drops, available with or without a prescription. Options include antihistamine drops, which block the release of histamines; mast cell stabilizers, which reduce inflammatory chemicals; or combination drops that target both. Since there are many options, it's helpful to discuss with your eye doctor which is best for you.
If you have other allergy symptoms such as sneezing or a runny nose, an oral allergy medication could address all of these at once. For persistent symptoms, a prescription steroid eye drop may be helpful.
If the urge to rub is not improving with artificial tears, cool compresses or over-the-counter drops, it's time to schedule an appointment with your eye doctor for an evaluation.